Confidence in cancer services in the Republic has been dented by recent controversies around the misdiagnosis of women with breast cancer, the new head of the State's cancer control programme, Prof Tom Keane, admitted yesterday.
Prof Keane, who took up his post last week, said his first task will be to try and rebuild confidence in the service, but he warned that there was no cancer centre in the world which didn't find cancer diagnosis problematic.
He said: "There somehow appears to be an expectation that . . . if you have a mammogram and it's said to be negative you can walk out the door being 100 per cent satisfied that you don't have cancer. That is clearly not true. It's not true in Canada, it's not true in Europe and it's not true in Ireland.
"The issue is what level of confidence you can have. I think the best estimates would suggest that with fully skilled staff, with all the proper facilities . . . you should have a 95 per cent certainty that the diagnosis that you've been given is correct."
The margin of error at Portlaoise hospital, where nine women were found to have been wrongly given the all-clear following a review of about 3,000 mammograms, was beyond that, he said.
He added that in British Columbia, where he was working up to now, specially trained cancer pathologists - who are in short supply worldwide - review the specimens taken from patients at local hospitals when they arrive at centres of excellence. "And the shocking statistic is that in 20 per cent of cases we make a change in some way in that diagnosis such that would influence the patient's treatment."
Prof Keane also told RTÉ's News at One that he would be implementing the plan to have eight centres of excellence for cancer care across the State, with four of them in Dublin. The strategy would not be reopened, he stressed. But he said that while patients would have to attend these centres for their initial diagnosis, which was critical, and initial management of their care including surgery, they could attend for chemotherapy at their local hospital.
"If the diagnosis is incorrect you can never expect to do well and if the initial treatment is incorrect you are playing catch up thereafter," he said.
He added that there will be a strategy to address travel for patients to the centres of excellence and he has been promised extra resources to implement the new cancer plan. More consultants, in particular, will be required and he is optimistic that a deal on a new consultants' contract can be reached soon to allow them be recruited.
Asked to comment on the fact that 97 women recalled to Portlaoise for a review of their care last week weren't informed as soon as it was known each of them needed to be seen again, he said: "I can't comment specifically but obviously timeliness is everything."
He added: "The ability to communicate rapidly to patients if errors have occurred or if there have been untoward events is absolutely required."
On the question of confidence in cancer services now he said: "There's been an erosion, I think, of confidence that people can go into their hospital and get a diagnosis that they can believe in. I think it's vital that that confidence be rebuilt and I think the national cancer control programme is going to have to have that as one of its major jobs."
The comment by Prof Keane on tests not always being perfect is borne out by a retrospective review of mammograms taken at Dublin's St Vincent's hospital between 1994 and 2004. The review, published recently in The Journal of Surgical Oncology, found 124 false negative mammograms over the period and of these 42 per cent were recategorised as suspicious.